Hierarchy is pervasive in healthcare, and current strategies to train providers to ‘speak up’ are not enough to overcome the intense challenges that hierarchy creates. In this episode, Vic talks with Taryn Taylor and Adam Garber about their recent articles in Advances in Simulation. Both studies explore the experience of practitioners working in teams managing obstetric emergences. Their studies use clever scenario design and delivery to re-create hierarchy and power gradients, as an example of ‘sociological fidelity’. 

Their insights are comprehensive, confronting but deeply resonant for healthcare professionals. We discuss their methods, their findings and what this might mean for simulation being part of the solution to addressing harms caused by hierarchy. 

The papers 

Pack, R., Columbus, L., Duncliffe, T.H. et al. “Maybe I’m not that approachable”: using simulation to elicit team leaders’ perceptions of their role in facilitating speaking up behaviors. Adv Simul 7, 31 (2022). 

Garber, A.B., Posner, G., Roebotham, T. et al. Facing hierarchy: a qualitative study of residents’ experiences in an obstetrical simulation scenario. Adv Simul 7, 34 (2022).